When Transgender People Go To Prison
Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a girl’s body, you thought that you were actually a boy.
Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the issue went much deeper than that. It was your core identity that was at stake. You knew that you were the other sex, at least in all ways except for the reproductive organs of your body.
You felt this way during childhood, but nobody seemed to understand or accept this about you. But you were dressed in the clothing of your biological gender and expected to participate in the activities stereotypically associated with it as well. Imagine that as your body matured in adolescence, you hated your penis if you had one, or likewise, you wanted to hide your developing breasts. You simply felt that you were trapped in the wrong body.
This experience is the gist of what transsexual or transgender persons face every day.
To some who have never met a transgender person, the concept itself may seem bizarre. I can assure you, though, that transgender people are not freaks; they are human beings who were born with a challenge that no person would choose to have.
Both in the community and in prisons, I have worked with several transgender patients over the years. They have taught me more about the challenges that they face every day than any book ever could have. Their life challenges, though, are magnified several-fold in jails and prisons.
The terms transgender and transsexual have approximately the same definitions, but transsexual is a medical term. However, please note that there is a great deal of debate and controversy about terminology that will be beyond the scope of this article. A brief overview can be found here.
Transgender does not imply anything about sexual orientation; it is all about gender identity.
Unfortunately, society can be a cruel place for anyone perceived as “different” from the norm. This issue could not be truer than in a prison environment.
Prisons in general are very black and white places. There are rules and regulations to handle different situations, and shades of gray tend to create confusion.
Men go to men’s prisons, and women go to women’s prisons. So, where do transgender people go?
Well, it depends. As far as I can tell, in most systems, those with a penis (present from birth or surgically constructed) go to men’s prisons. Those with a vagina go to women’s prisons. Sounds simple, right?
Not at all. First, assuming that the transgender person has not been taking hormones and has not had sex reassignment surgery (sex-change operation), he or she will likely have to psychologically endure being housed in an institution for those that the person perceives as being of the opposite sex.
What if a person with male genitalia who believes himself/herself to be female has started taking female hormones before the incarceration and has fully-developed breasts? Then, the person would likely end up in a men’s prison. That’s right, a penis and breasts, in jail with a bunch of men.
It is pretty easy to see how there are various possibilities that present challenges since transgender people do not easily fit into male and female categories.
Once incarcerated, regardless of the gender of their inmate peers, there are other challenges.
How can they avoid discrimination? My guess is that most security personnel in most institutions are not well-versed in working with transgender inmates. People often fear what they don’t understand, and there is a significant risk of these prisoners not being treated fairly. Likewise, I believe it’s rather obvious how transgender inmates potentially face significant harassment, intimidation, and violence from other inmates.
What about hormone treatment in prisons? Should inmates who are already receiving it on the outside be prescribed these medications in prison, too? What about sex reassignment surgery? Should taxpayers bear the burden of this for long-term prisoners? Some have argued that they should.
How should one address a transgender person: “he” or “she”? I’d suggesting asking them how they wish to be addressed. However, I will say that every transgender patient I’ve ever worked with wanted to be addressed as the sex they felt they really were, not as the gender into which they were born. This presents an interesting dilemma in a correctional environment because referring to any inmate as “she” in a men’s prison or vice versa elicits shocked and confused reactions from prison staff.
My purpose of this post is to raise awareness about challenges faced by transgender inmates, an issue that I rarely hear discussed and about which there is much ignorance. Transgender people deserve to be treated with dignity and respect just like anyone else. They deserve not to be discriminated against, and they deserve to be safely housed if incarcerated. However, there are many details involved in their custody and health care that will never be simple to solve.
To read a very recent NY Times article about transgender people and name changes, click here.
What are your thoughts about or experiences with this topics? Please share your comments.
Update 3/7/10: This article appeared as a guest post on the popular medical blog, Kevin MD, on 3/2/10. As of this update, there were 11 comments after the post. Click here to go to KevinMD to read them.
Tough topic and I applaud your both raising the subject, and inviting dialogue. I work in a small jail, near San Quentin, North Bay, California. In our small jail we do occasionally house transgendered inmates. It is the policy that if you have the equipment, to go to the housing unit with others who share your same equipment. Regardless of your self perception about what gender you are. The way I understand this, in a basic way, is that to put a Male to Female trans-gender person in the female ward, invites the possibility of pregnancy in custody. I get this completely, because the invitation for a lawsuit for not “protecting the women” is far too great. Rape isn’t even the issue, it is the complexity of the human mind, criminological thinking, and the delight with the possibility of “getting back at the system”. I find people far too wiling to take advantage of the system, and not necessarily in custody to rehabilitate themselves to be better citizens. Unfortunatley, and I do believe people can change.
On the same hand, feminized men in male housing units invite tremendous challenges to custody for their protection as well. Those men are vulnerable to the other inmates, at risk for rape, violence, and objectification. Don’t even start with the prevention concept of STD’s, HIV, HEP C in jails and prisons Those same trans-gender inmates find find themselves in powerful positions for the elicit trade and prostitution market. Depending both on what they are willing to do, and how they perceive themselves as victims, or even unwillingly accept that victim role simply to survive.
My belief is if someone has gone the full mile to obtain a full trans-gender surgical procedure, and can make the full adjustment to the assigned gender in all ways, they should be assigned to their new gender housing. End of Story.
Feminized men must be placed in protective custody, and watched very carefully for signs of victimization and elicit trade. It is not ideal by any means.
I have also been called to testify as to why the service I represent would not provide hormone injections for a male to female inmate. He was in fact on oral hormones, and as some of the nurses I work with stated “His breasts are bigger than mine” In this case, he was headed to prison, and was fighting to get on the injectable drug was IMHO to more or less pave the way for the same treatment in prison. Now it may be different in California Prisons, I think that lawsuit has been won, and that Trans-gender Disorder is in the DSM-IV, and the treatment prescribed is in fact hormone treatment.
Because my primary concerns are for the patient, with the dwindling budget I manage, I often have to juggle opposing beliefs within myself. In this case I clearly had to think through what the objectives were for my service, the costs to the community I serve, the patients actual versus percieved needs and what constituted an urgent or emergent condition, and act accordingly. In court I did not support his receiving injectable medicine. And to this day, I do feel that was the appropriate opinion for me to render.
After the court appearance, a nurse came to me and told me of a conversation with the inmate. She had asked him why he wanted the injectable medicine so badly, as the oral medicine seemed to be working fine. He was by the way, in protective custody and there was a fight between two men over ‘him’ and he had been providing sexual favors even in PC. HE told the nurse “I want to lactate, isn’t that what real women do?”